Provider Demographics
NPI:1467426916
Name:CHAN, JOANNE (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:
Last Name:CHAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 FAME AVE
Mailing Address - Street 2:SUITE 135
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-1587
Mailing Address - Country:US
Mailing Address - Phone:717-632-3235
Mailing Address - Fax:717-632-7292
Practice Address - Street 1:250 FAME AVE
Practice Address - Street 2:SUITE 135
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-1587
Practice Address - Country:US
Practice Address - Phone:717-632-3235
Practice Address - Fax:717-632-7292
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD060005L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0016387940005Medicaid
PA909874Medicare ID - Type Unspecified
PA0016387940005Medicaid